Testing a decisional balance worksheet for substance abusers: Factors related to intentions regarding treatment and abstinence

In search of new strategies for the war on drugs, policy makers have recently turned to early intervention programs. These programs often refer substance abusers into treatment long before they have accumulated the serious consequences that conventional treatment programs use to motivate their voluntary clients. Recent studies have indicated that it is not the accumulation of negative consequences, but the subjective perception of these consequences that contributes to motivation for treatment and abstinence. Several prominent investigators have recommended using decisional balance methods to study subjects' perceptions of the pros and cons of using drugs and alcohol. This dissertation involved the development and testing of an innovative Decisional Balance Worksheet (DBW). The DBW was designed to address three fundamental limitations of existing measures: (1) conventional measures use experimenter compiled lists of positive and negative effects of drugs and alcohol, (2) they neglect to consider the costs and benefits of abstinence, and (3) they generally obtain only one or two subjective ratings of each effect. By using subject generated lists of pros and cons of use and abstinence and five standardized rating scales, the DBW combines the sensitivity of an idiographic assessment tool with the utility of a nomothetic research measure. The DBW was tested in three treatment settings: (1) an intervention group for intoxicated drivers, (2) an outpatient program for chemically dependent adults, and (3) an inpatient detoxification unit. Dependent measures included subject ratings of behavioral intentions regarding treatment and abstinence, ratings by clinicians, and records of attendance. The validity and utility of the DBW were supported by several methods of analysis. The mechanics of the worksheet proved to be feasible. The five rating scales were reasonably independent. Mean ratings of both the negative effects of use and the positive effects of abstinence were significantly correlated with measures of interest in treatment and abstinence. Ratings of perceived control over these effects also produced interesting results. Subjects' comments about completing the DBW supported the clinical utility of the worksheet. These results were consistent with the findings of prior investigators. Several promising clinical and research applications for the DBW were identified and discussed.